Measles on the Rise

  

The Global Measles Epidemic Isn’t (Just) About Measles

Strong health systems, along with immunization efforts, are key to fighting disease around the world.

By Andrew SchroederAPRIL 20, 2019 6:00 AM

Measles, once a common and deadly childhood illness which had been declared “eliminated” from many parts of the world including the United States, Canada and Europe nearly two decades ago, is back on the global health agenda.   Measles cases globally rose nearly 300 percent in the first quarter of 2019 as compared with the first quarter of 2018, according to surveillance data covering 190 countries released last week from the World Health Organization.

Over 112,000 cases were reported to start this year, as opposed to just over 28,000 from the beginning of 2018. That year likewise saw a significant gain as compared to 2017. Although still not close to the shocking levels of the mid-20th century, when tens of millions of children were infected and millions died, the trend for new measles infections seems to be inexorably and frustratingly on the rise.

This trend places children under the age of 10, particularly in poor and conflict-affected parts of the world, at increasing levels of entirely avoidable risk.

This global map diagrams the areas of the world where there are ongoing problems with measles

MEASLES, CONFLICT AND HEALTH SYSTEMS

In addition to the effect of vaccine hesitancy, we need look no further than the WHO’s own country-level data on the locations and growth trends of measles cases.

Almost all the enormous jump in measles cases from 2017 until the beginning of this year is attributable to a handful of places. This year, almost two-thirds of the entire reported global measles caseload is attributable to just two countries: Ukraine and Madagascar.  These two countries are highly instructive as to the true reasons why we should pay attention to measles as something like a “canary in the coalmine” for the underlying weaknesses of public health systems.

Let’s start with Ukraine, which may appear, at first glance, to be the most puzzling.

Why should a middle-income country on the edge of Europe, with a historically reliable, near-universal public health system, suddenly become a kind of poster child for the rampant spread of infectious childhood illnesses for which immunization exists? The answer is pretty simple: conflict.

Prior to 2014, Ukraine maintained a measles vaccination rate of 95 percent, generally considered the gold standard level for herd immunity. Then, conflict broke out between Ukraine and Russia. As a result, the Ukrainian Ministry of Health budget was frozen and measles vaccination procurement largely ceased until late 2015. By 2016, Ukraine’s vaccination rate had plunged to just 41 percent, one of the lowest rates on the planet.

In subsequent years, the vaccination rate in Ukraine crept back up close to its pre-conflict levels, with about 91 percent coverage achieved last year. But the damage had been done. A multi-year cohort of Ukrainian children had lost their immunity to the disease. Combined with widespread disruption of the primary health care system, and the physical effects of conflict on large numbers of communities, measles took root again quickly and began to spread.

Some of the migration of measles from the Ukraine epidemic has apparently gone international, with cases in New York, Israel and elsewhere traced directly to index cases of travelers from Ukraine.

Elsewhere, in places from Yemen to Nigeria, one can also detect the sharply negative impact of conflict on basic health system capacities and measles infection rates. The lessons of the Ukrainian measles epidemic, as is also the case with these other countries, are not only that it doesn’t take much to fundamentally disrupt a well-functioning health system and produce an otherwise preventable outbreak. Disruptions to health systems in one country, given high levels of global mobility through air travel, can quickly be felt in many places throughout the world.

THE GLOBAL MEASLES RESURGENCE

One of the most common explanations in the media for the measles resurgence has to do with a set of beliefs promoting reluctance to follow through with childhood vaccinations. The WHO earlier this year labeled this emerging reluctance one of the world’s “top ten” threats to global health.

The spread of misinformation about childhood vaccination is leading to a wave of what the World Health Organization calls “vaccine hesitancy.” Over time, declining tendencies to follow through on evidence-based public health recommendations may threaten long-established successful practices, which have improved the health of children since the mid-20th century.

In parts of California, New York, and Washington State, for instance, there is evidence that relatively small outbreaks have been correlated with reduced vaccination rates due to anti-vaccine misinformation combined with the novel introduction of the virus, often through travelers.

Globally, however, how can the disease’s resurgence be explained? Without question, the world needs to remain vigilant to any possibility that the consensus around childhood vaccination may be undermined over time by rising “vaccine hesitancy.” However, large numbers of people around the world are still not able to access the vaccinations they both want and need.  

Measles, respiratory illness with a characteristic rash, is extremely contagious. Although most people who contract the disease will recover, a small fraction of young children goes on to develop more severe complications, including pneumonia and encephalitis, a swelling of the brain that can cause permanent brain damage or even death. 

THE PERIL OF UNDER-FUNDING HEALTH CARE

The ongoing situation in Madagascar, which Direct Relief continues to respond to with local partners including the Ministry of Health, is quite different from that in Ukraine. Madagascar is one of the least developed countries, with a Human Development Index (HDI) that ranks 161st out of 189 measured countries. Its public health budget has been constantly under pressure for many years simply due to the tradeoffs required to manage multiple emerging health threats to rapidly changing communities. As a result, the measles vaccination rate in Madagascar has fallen to one of the world’s lowest at 58 percent.

Vaccination is not the only element of the health system that leads to an increased likelihood of measles contagion.  Poor nutrition leads to weakened immune systems for children and diminished capacity to resist infection. This is one of the key reasons why Direct Relief has been assisting with distributing of high-dose vitamin A to strengthen immune systems for vaccinated and unvaccinated children alike.

Weak primary care systems also present challenges to ensuring that all children are regularly seen by a physician and that suspect cases of measles are quickly identified and treated. Combined with low vaccination rates and persistent under-nutrition, weak primary care and disease surveillance can allow cases to multiply well before there is a chance to identify and intervene.

THE KINDLING THAT SPARKS AN OUTBREAK

Measles is well suited to epidemics given these system weaknesses. The reproduction rate for measles, the number epidemiologists use to measure the likelihood that one infected person infects others in the absence of counter-measures, is very high.

A systematic review in The Lancet from 2017 confirmed an average reproduction rate of 18, with considerable observed variance depending on contextual factors including poverty and the strength of health systems. That means a single measles infection may commonly produce at least 18 new infections in the absence of counter-measures. Likewise, measles is infectious for 7 days prior to the individual becoming symptomatic, which means that infections can easily spread undetected. That astonishing rate of transmission, including challenges with early detection, is what constantly threatens to transform measles outbreaks into exponentially growing epidemics.

In addition to defending the core public health value and practice of mass vaccination, we still have a long way to go to achieve a genuine universality of vaccine access, not to mention the related health systems interventions that maximize the chances of children to resist infectious diseases. That lack of equitable access threatens the most vulnerable in those countries most of all. But it threatens communities far outside their borders to given the fluency of global trade and travel.

Weak primary health systems, whether born of conflict, poverty or, as is often the case, a combination of both, remains among the greatest threats to human health everywhere.

Appeals court strikes down ACA's individual mandate

Just about the time the House of Representatives voted to forward their  "Impeachment resolution to the U.S. Senate, a ghost of another haunting has risen from the dead.

The Individual Mandate of the ACA assures that no one can be denied health insurance based upon previous medical conditions.

A federal appeals court on Wednesday ruled that the Affordable Care Act's individual mandate is unconstitutional, but ordered a lower court to take a fresh look at how much of the rest of the law should fall along with it.

What's next: This decision will likely keep the ACA's protections for pre-existing conditions in legal limbo well past the 2020 election.

The intrigue: Republican attorneys general have argued that congressional Republicans’ 2017 tax law, which nullified the ACA's individual mandate, made that policy unconstitutional.

• A panel of the 5th Circuit Court of Appeals said Wednesday that it agrees.
• Republicans, and the Trump administration, have said the courts should strike down the entire law along with the mandate.
• The 5th Circuit wrestled during oral arguments over how much of the law to strike down, ultimately deciding to kick that question back to the lower court for a new hearing. That lower court previously said the entire law would have to go.

Yes, but: The individual mandate is now essentially toothless, and it turned out not to be particularly effective when it was in effect.

• So, if the court is inclined to strike down the mandate alone, letting the rest of the law stand, that would be a much safer proposition than it appeared to be in 2012.

Go deeper: Government funding bill deal will repeal key ACA taxes

Why it matters: The decision is a colossal win for the health care industry.

• If this wasn't good enough news for the industry, the deal won't address surprise medical bills — and it avoids prescription drug prices except for the CREATES Act, which helps generics get to market faster.
• The taxes have been repeatedly delayed. And while the industry has pushed for their repeal for years, it hasn't yet been successful.

Between the lines: Voters are decidedly not asking Washington to lift industry taxes while avoiding dealing with two of the most popular health care issues, but if that's how this plays out, it's a great indicator that the industry's lobbying strength is as good as ever.

• It's also a good sign that cost control — the intention of the Cadillac tax, a 40% excise tax on the most generous employer plans — is still not very popular with lawmakers, even as health care costs continue to rise.
• The tax was expected to raise $200 billion over 10 years.

The other side: The industry says that the ACA taxes end up getting passed along to patients.

Go deeper:

• The Affordable Care Act's free health plans
• SCOTUS seems to side with insurers in ACA risk corridor case
• The return of the ACA wars

REFERENCE:

Some Essentials about Medicare Enrollment Period

Medicare Enrollment Period It is that time of the year. In mid-October until early December 7th is the enrollment period for Medicare and Advantage Programs. It is a weird set of dates, and each year it is extended, for one reason or another.  This year it is because there was a last-minute rush. I am not certain what that means? Was the Health care.gov web site overloaded, hacked or some other governments misdirect?  Now you have another chance to enroll.....until mid-January You can assign an authorized representative to accomplish these tasks 1.Create a Medicare.gov access 2.Select your plan(s) 3. Register a favorite physician, hospital, durable medical goods and more. Would you like for a family member or caregiver to be able to call Medicare on your behalf? Medicare can't give your personal health information to anyone unless we have permission in writing first. There are 2 ways to give permission:   (1) Print and fill out form CMS-10106: "Authorization to Disclose Personal Health Information" and then mail it to us. OR   (2) Submit the form online with a Medicare account.  Don't have a Medicare account yet? Signing up is easy and gives you electronic access to your health information. Once you've signed up, fill out and submit the form online by following these steps: Click on your name in the top right corner of the page. Click "My account." Select "Manage my representatives." Click “Medicare Authorization to Disclose Personal Health Information form."  Enter the requested information and click the "Continue" button. If all else fails go to the following url (it goes in the box at the top of your browser screen) .  http:/medicare.gov Get Started Sincerely, The Medicare Team Note: People living in New York have additional steps they must take. View the "Authorization to Disclose Personal Health Information form" to learn more.

You can update your preferences or use ou

'Residents From Hell': Indignities and Outcomes in Medical Training

We have all heard the stories of physician burnout and suicide. Medical training is arduous, difficult and long. Even with supportive mentors and teachers, it will take a toll on trainees.

This is a story of one such event.

The story is told,

"Don, my resident, grabbed me by the collar and pushed me against the wall of the empty hospital corridor.

"What the hell were you thinking, Pies?" he growled, his breath hot against my face. "Did you not consider that Mr A could be septic?"

"I'm sorry, Don!" I said miserably, my heart knocking against my rib cage.

"Don't apologize to me! Apologize to Mr A! He could have died if I hadn't found your screw-up!"

"I know, I know, Don. It's just that—I assumed the systolic reading…"

"Damn it! How many times have I told you? Assumption is the mother of screw-up!"

Don used a coarser term than "screw-up." He never minced words or missed an opportunity to let me know what a pitiful excuse for a medical intern I was. He was one member of the duo I used to call "The Residents From Hell." Together, Don and Phil (not their real names) helped make my medical internship one of the most painful experiences of my entire life. Yet, despite the numerous psychic traumas they inflicted on me, these two skilled physicians also helped me become a better doctor.

I had entered my internship with a pretty high opinion of my medical knowledge. Having majored in biology at Cornell University and has earned "honors" in my internal medicine course, I had some basis for my delusion of grandeur. But I soon discovered, among many similar revelations, that knowing the physiology of sepsis is not the same as detecting it in an older patient. Mr.  A proved the point.

A thin, frail gentleman in his 70s, Mr. A had been admitted to the medical unit with some vague symptoms the staff described, lazily, as "the dwindles"—a 10-lb weight loss over the past month, poor appetite, and a general sense of malaise. At the time of admission, no one had considered sepsis in the differential diagnosis. Mr A did not show any of the classic signs of sepsis, such as fever and chills, low body temperature, decreased urination, rapid breathing, or a low systolic blood pressure.

However, with that last finding, I made a potentially lethal assumption. I had checked Mr A's blood pressure while he was sitting on his bed, but I failed to check for an orthostatic drop in blood pressure. I assumed that a reading of about 105/70 mm Hg (as I recall) was an accurate reflection of the patient's hemodynamic state. But when Don checked Mr A's blood pressure when he was standing, the reading was an ominous 85/55 mm Hg—a huge drop, potentially signifying sepsis.

Emergency physician Justin Morgenstern, MD, has described the wide range of cognitive errors that lead doctors to make serious mistakes. Among them is ascertainment bias: we "see what we expect to see." For example, a disheveled, homeless man staggering into the emergency room, slurring his speech, is assumed to be "drunk" when he is actually hypoglycemic. When Mr A was admitted to our unit, I expected to see someone who was either depressed (I was, after all, heading into a career in psychiatry) or showing signs of a covert malignant tumor. I was not expecting to see someone in the early stages of sepsis. Morgenstern also describes "value bias," sometimes known as "effective error" and defined as "the tendency to convince yourself that what you want to be true is true, instead of less appealing alternatives."

Clinical depression was a diagnosis I probably "wanted to be true" because I was familiar with it and knew how to treat it. Sepsis, not so much. Whether we see what we expect to see or convince ourselves that what we want to be true is true, we are making unwarranted assumptions. And as Don was trying to teach me, assumptions can come with consequences.

I'd be lying if I said that I appreciated Don and Phil's tutelage at the time they were tormenting me. Far from it. Although they taught me to question my assumptions and avoid premature diagnostic closure, they also taught me, firsthand, the pain of humiliation and indignity. I still remember, on another occasion, standing outside my newly admitted patient's room, alongside my medical student, and Phil saying with icy composure, "Pies, don't kill this patient!" Maybe he thought he was being funny. Or maybe he was trying to goad me into being the kind of meticulous clinician we all want to be. But Phil's words left me feeling like an insect crushed beneath his heel. I recall that brain-searing insult with a wince, even now—over 40 years later.

That font of Jewish ethics, the Talmud, likens humiliating another human being to "spilling blood"—perhaps reflecting the fact that our faces tend to blanch when we experience public humiliation. And yet, as Friedrich Nietzsche once said, "Anything that doesn't kill me strengthens me." Although nothing can justify the deliberate humiliation of another human being, Phil and Don's "instruction" taught me to overcome my wounded feelings and get the job done. And their deplorable indignities taught me to aim higher in my own treatment of patients, colleagues, and students.

Yes, I learned from Don that "assumption is the mother of screw-up." That lesson has served me well, particularly when considering the differential diagnosis of a medically complicated patient. What looks at first like schizophrenia may ultimately turn out to be tertiary syphilis—the "Great Masquerader." What seems to be understandable grief or depression can turn out to be the early signs of pancreatic cancer.

However, the most valuable lesson I took from "The Residents From Hell" is to treat all persons—especially those with little power—with courtesy and dignity. To be sure: Diagnostic acumen is the foundation of good medical care. Don and Phil possessed that trait in abundance. Yet atop that foundation stands the House of Medicine—its essential constituents being respect, compassion, and kindness.

This story illuminates a not so uncommon scenario in medical education. Fortunately, it seems to be diminishing. The mantra of "I went through it, so you can too." This extends to hazing, bullying, night call, extensive on-call hours and 24 hour days. Ten years ago or so a standard was implemented to strictly decrease work hours and to restrict certain behaviors by senior physicians towards house staff residents). However, there remain pockets of misbehavior. The behavior also extends to junior attending staff in some universities and hospital organizations.

So too, are other instances of meaningless rituals in medical care

Advances in Treatments

Advances in Treatments: As reported by the Cleveland Clinic


Led by Michael Roizen, M.D., Emeritus Chief Wellness Officer at Cleveland Clinic, a panel of physicians and scientists have selected, in order of anticipated importance, the top new innovations healthcare providers can expect to see by 2020.

1. Dual-Acting Osteoporosis Drug
Osteoporosis is a condition where bones become brittle and increase the risk of breaking often without symptoms until the first fracture. But recent Food and Drug Administration approval of a new dual-acting drug called Romosozumab could offer more control in preventing more fractures.

2. Minimally Invasive Mitral Valve Surgery
The Mitral valve allows blood flow from the heart's left atrium to the left ventricle. However, for some patients older than 75 years the value may be defective and result in regurgitation. Expanded approval of a minimally invasive valve repair device for patients who don't experience improved symptoms could be a new treatment option.

3. Inaugural Treatment of Transthyretin Amyloid (ATTR-CM)

Cleveland Clinic physicians view ATTR-CM as a disheartening progressive, underdiagnosed and potentially fatal disease. Amyloid protein fibrils deposit in, and stiffen the walls of the heart's left ventricle. But there is a new agent to prevent misfolding of the deposited protein that shows a significant reduced risk of death. Three fast-track FDA approvals in three years now have led to the first-ever medication for this condition.

4. Therapy for Peanut Allergies.
There may be new hope for children with severe peanut allergy, a condition that not only is potentially fatal but also can cause much anxiety for both children and parents alike.

This week, 2 new studies discuss research findings on the use of oral immunotherapy in children with peanut allergies, which affects up to 1.4% of children in high-income countries. Oral immunotherapy involves having individuals with an allergy to a substance ingest a tiny amount of that substance under close clinical monitoring, and gradually increasing this exposure over an extended period of time. The goal is to eventually reach a point where the body can tolerate a reasonable amount of the substance without a severe allergic reaction, at which point the individual is deemed “desensitized.”

Peanut Allergy

Closed-Loop Spinal Cord Stimulation

This treatment uses an implantable device that sends an electrical stimulus to the spinal cord for the relief of chronic pain. Unfortunately, unsatisfactory outcomes from subtherapeutic or over-stimulation events are common. Closed-loop stimulation can enable improved communication between the device and the spinal cord, giving optimum stimulation and pain relief.

6. Biologics in Orthopaedic Repair

When patients have orthopedic surgery, their bodies can take a considerable amount of time to recover, sometimes for years. Use of biologics that include cells, blood components, growth factors and additional natural substances can harness the body's own power and promote healing, and these substances are finding their way into orthopedic care to expedite improved outcomes.

7. Antibiotic Envelope for Cardiac Implantable Infection Prevention

Each year about 1.5 million patients get an implantable cardiac electronic device. Yet, infection remains a real danger. Available now are antibiotic envelopes to encase the cardiac devices and prevent infection.

8. Bempedoic Acid for Cholesterol Lowering in Statin Intolerant Patients
While typically managed by statins, some patients experience unacceptable muscle pain with statins. The use of Bempedoic acid can provide an alternative approach to lowering LDL-cholesterol and avoid side effects.

9. PARP Inhibitors for Maintenance Therapy in Ovarian Cancer



PARP, or poly-ADP ribose polymerase inhibitors, block repair of damaged DNA in tumor cells which increases cell death, especially in tumors with deficient repair mechanisms. One of the most important advances in ovarian cancer, PARP inhibitors have improved progression-free survival and are now being approved for first-line maintenance therapy in advanced-stage disease.

10. Drugs for Heart Failure with Preserved Ejection Fraction

This is a condition in which the ventricular heart muscles contract normally, but do not relax as they should. With preserved ejection fraction, the heart does not properly fill with blood, leaving less blood being pumped out into the body. Current recommendations merely cover symptom relief. Now, SGLT2 inhibitors, a class of medications in the treatment of type 2 diabetes, are being looked at as a new treatment option.

Source:  Health Data Management

Real Medical Tricorder - ViATOM Checkme

Hump Day check-up.  Bones, check this one out.



Smart devices have come a long way.

The Viatom CheckMe has the following functions. This card-sized device while strictly speaking is not wearable, it provides a near 'tricorder' solution.

Supports both cable and cable-free operation

500 Hz sampling rate and wide bandwidth

30/60/90s of full disclosure waveform can be replayed

A Professional ECG algorithm is able to provide
not only Heart Rate but also QRS duration, ST
segment, and rhythm analysis

Supports both cable and cable-free operation

Built-in SpO2 sensor supports cable-free
operation

External soft-cover SpO2 sensor is available

External SpO2 ring sensor is available

External disposable SpO2 sensor is available

Oxygen saturation, pulse rate, and pulse strength are available

*****************************************************************************

In addition to this 'carry', wearable sensors have exploded from the simple "Pebble" smartwatch to "Fitbit" now owned by Alphabet (ne Google), Apple's 4th generation smartwatch and a multitude of  $ 99 lookalikes and wannabees (that are most likely built in the same Chinese factories as Apple. Don't forget Samsung Gear and other  Androgenous offerings.

Most of these offer Bluetooth connectivity to either iPhone, or Android phones.

This is a very rapidly developing niche, what is good this year will probably be obsolete in six months.  Some of these devices have the stamp of approval from the Food and Drug Administration. If so the package will say 'FDA approved"

Here are a few videos graphically displaying a number of Android and Apple Watches. If possible find a place where you can physically examine and try on the watch. There are many determinants of what will suit you.

1. Size
2. Weight
3 Color
4. Watchband material (soft, hard, metallic)
5. Fit and wearability (is it light, bulky
6. Screen visibility (some are auto-adjusting to light levels, and some screens are difficult to read due to reflectivity.
7. Battery life, and time to charge. There are some highly variabilities in the group, including wireless charging
8. Decide if you want GPS, Vital sign tracking, Cell coverage, messaging, Some watches offer downloadable apps much like your smartphone.
9. Talk to your friends and experts at electronic stores.
10. Use Google and Amazon to research the web.
11. Visit Techcrunch.com  Gizmodo.com

Sony's upcoming health platform is an easy-to-implement wearable for remote monitoring companies

Compared to Samsung, Microsoft, Apple or several other big-name electronics companies, Sony has had a fairly limited presence in the realm of digital health. To carve out its niche, Stromberg said that the mSafety platform focuses on network Sony’s technical and design strengths while leaving the particulars of health data monitoring and interpretation to its clients. 

Sony is also looking to establish itself as a long-term partner to young digital health and remote monitoring companies. Stromberg said the company is committing to multi-year support for any devices it’s putting out the door — an especially pertinent selling point in the realm of medical devices — and hopes that its reputation as an established hardware manufacturer will win over new partners. 

There is a great untapped market developing for Clinical studies using wearables and/or remote monitoring.  

Novartis, Otsuka, Pfizer, Sanofi commit to new trials on Verily's digital research platform

Verily smartwatch from Alphabet comes to the market as an FDA 510K approved device. This because it will be used for hard medical science and pharmaceutical research.

Alphabet company, today announced a new Project Baseline initiative, the Baseline Health System Consortium, comprised of Verily, Duke University Health System, Vanderbilt University Medical Center, University of Mississippi Medical Center, Mayo Clinic, Regional Health in South Dakota and the University of Pittsburgh. The strategic collaboration will identify and develop solutions to significant challenges in clinical research, including making research more accessible and engaging for patients, clinicians, researchers and research sponsors alike.  Many users will be enabled by researchers themselves as a necessity to carry out their clinical trials with patients that are widely dispersed geographically.

The Very Best Smartwatches of 2019

Apple Smart Watch Video

Fitbit Video

The Best Android Smartwatches

How Congress Can Make Real Progress on Drug Prices

Doug Badger

Visiting Fellow

Doug Badger is a Visiting Fellow in Domestic Policy Studies at the Heritage Foundation.

The House of Representatives is scheduled to vote this week on H.R. 3, the Lower Drug Costs Now Act, which would impose federal price controls on prescription medicines. The bill would limit Americans’ access to lifesaving therapies, impede the development of new treatments for deadly and debilitating diseases, and inflict harm that vastly exceeds the budgetary savings it promises.

Congress should reject the policies of H.R. 3 and pursue drug-pricing reforms that encourage innovation. Specifically, Congress should reform Medicare prescription drug payment programs and practices that prevent affordable generic medicines from coming to market. Such reforms include restructuring the Medicare Part D program to protect seniors from high out-of-pocket drug spending and refining federal laws that brand-name manufacturers are exploiting to prevent competition from generics.

These proposals enjoy overwhelming support among both parties in the House and Senate and could be signed into law by the President. All proposals are included in an alternative bill (H.R. 19) released by House Republicans on December 6.1

H.R. 19, The Lower Costs, More Cures Act, section-by-section summary released by House Republicans, December 6, 2019. H.R. 19, as outlined in this document, contains many proposals approved with bipartisan votes by the Senate HELP Committee (S. 1895, The Lower Health Care Costs Act) and the Senate Finance Committee (S. 2543, The Prescription Drug Pricing Reduction Act).

 Acting on these reforms would provide relief from high prescription drug prices, while fostering continued medical innovation that will cure diseases, lengthen life expectancy, and improve quality of life.

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H.R. 3: The Wrong Path

The Lower Drug Costs Now Act would reduce drug prices by government fiat, jeopardizing the quality of health care that Americans deserve.

What is worse is that H.R. 3 will not reduce drug prices at all because it will not become law. The House vote on the measure is expected to split largely along party lines, the bill lacks support in the Senate, and it is expected to face a veto threat from President Donald Trump. If Congress cannot move beyond the flawed and divisive H.R. 3 and toward effective reforms, it will adjourn next year having done nothing about drug prices.

Drug-pricing reform need not fall victim to partisan squabbling. There is broad bipartisan support for proposals to reduce prescription drug prices. Democrats and Republicans have reached a rare consensus on this contentious issue, backing reforms to Medicare prescription drug coverage and supporting a ban on practices that impede the entry of affordable generic drugs into the marketplace.

By shunning these broad-based reforms in favor of a vote on H.R. 3, House leaders have chosen partisan posturing over bipartisan progress on drug prices.

A better path is needed.

 Table 1 compares the proposals with the current law.

How Congress Can Make Real Progress

Making Medicines Affordable for Seniors: Reforms to Medicare Payment Practices. The federal government, through Medicare, helps seniors and people with disabilities to access prescription drugs via two programs: Medicare Part D and Medicare Part B. Both programs need reform in order to address policies that provide flawed financial incentives to drug makers and insurance companies that are driving up prescription drug costs.

Part D Restructuring. There is a broad consensus on the need to reform Medicare prescription drug coverage. Members of both parties agree that the Medicare Part D benefit, which was created in 2003, requires restructuring.

Under Medicare Part D, drug prices are set through negotiations between private pharmacy benefit managers and drug manufacturers without government involvement. Competing prescription drug plans sponsor insurance policies that cover drugs and set their premiums. The government subsidizes these premiums at fixed rates. Prescription drug plans compete for seniors’ business based on quality and price. Seniors can choose the plan that provides them the best value, covering the medicines they take at the most affordable prices.

Consumer choice and competition have made Part D the rarest of government programs: one in which spending has not spiraled out of control. In fact, government actuaries report that federal general revenue spending on the program was $67.8 billion in 2018. That is less than the amount that the government spent on Part D in 2015 ($68.4 billion).2

Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplemental Medical Insurance Trust Funds, The Boards of Trustees, Federal Hospital Insurance and Federal Supplemental Medical Insurance Trust Funds, April 22, 2019, Table III.D3, p. 103.

Over that same period, government spending on Medicare Part A (hospital inpatient benefits) increased by 10.5 percent (from $279 billion to $308 billion),3

Ibid., Table III.B4, p. 52.

While general revenue spending on Part B (physician and other outpatient benefits) grew by 24.2 percent (from $203.9 billion to $253.2 billion).4

Ibid., Table III.C4, p. 85.

The Part D program has also resulted in reduced spending elsewhere in the Medicare program by making drug therapies broadly accessible to seniors. Multiple studies have found that these therapies help to keep beneficiaries out of hospital beds and emergency rooms, reducing Medicare spending on hospitals and doctors.

For example, the Congressional Budget Office (CBO) estimates that a 1 percent increase in prescriptions filled by Medicare beneficiaries reduces spending on medical services by 0.2 percent.5

Congressional Budget Office, “Offsetting Effects of Prescription Drug Use on Medicare’s Spending for Medical Services,” November 2012, p. 1, https://www.cbo.gov/sites/default/files/112th-congress-2011-2012/reports/MedicalOffsets_One-col.pdf (accessed December 9, 2019).

 Applying the CBO methodology, Chris Pope of the Manhattan Institute estimated that an extra $100 in prescription drug use by Medicare beneficiaries can be expected to reduce the program’s spending on other medical services by $95, while delivering better outcomes.6

Chris Pope, “Issues 2020: Drug Spending Is Reducing Health Care Costs,” Manhattan Institute, November 6, 2019, p. 3, https://www.manhattan-institute.org/issues-2020-drug-prices-account-for-minimal-healthcare-spending (accessed December 9, 2019).

Relying on different economic assumptions, a December 2016 study by economist Robert J. Shapiro found that the Part D program had produced net Medicare savings of $679.3 billion between 2006 and 2014.7

Robert J. Shapiro, “The Value of the Medicare Part D Program for its Beneficiaries and the Medicare System,” Progressive Policy Institute, December 2016, p. 5, https://www.progressivepolicy.org/wp-content/uploads/2016/12/The-Value-of-the-Medicare-Part-D-Program.pdf (accessed December 9, 2019).

The Part D program has achieved these results through competition among prescription drug plans and through a standard drug benefit that apportions costs among beneficiaries, plans, manufacturers, and the government.

The program’s complex benefit structure could nonetheless be improved. While drug plans and beneficiaries finance prescription drug spending for the vast majority of seniors, the taxpayers shoulder 80 percent of the burden of the small minority of seniors whose annual drug spending falls into the program’s catastrophic tier (annual spending that exceeds $8,140).

Although overall Part D spending growth has been quite modest, the Medicare Payment Advisory Commission (MedPAC), an advisory arm of Congress, has noted that spending in the catastrophic tier grew from 25 percent of Part D costs in 2007 to 54 percent in 2017.8

Medicare Payment Advisory Commission, “Report to the Congress: Medicare Payment Policy,” March 2019, p. xxv, http://www.medpac.gov/docs/default-source/reports/mar19_medpac_entirereport_sec.pdf (accessed December 9, 2019).

 MedPAC attributes this in part to the program’s benefit structure.

There is broad congressional support for restructuring the Part D benefit. Several proposals have emerged. While they differ in detail, they share two important features: They cap the amount that seniors spend annually on prescription drugs, and they shift financing in the catastrophic tier from taxpayers to Part D plans and drug manufacturers.9

For a detailed analysis of these various options, see Tara O’Neill Hayes, “Competing Proposals to Medicare Part D,” American Action Forum, September 23, 2019, https://www.americanactionforum.org/insight/competing-proposals-to-reform-medicare-part-d/ 

Reference:

Life, Liberty and Levin: Sally Pipes dispels myths surrounding single-payer health care proposals | Fox News Video

Health care expert discusses the Affordable Care Act, rising prescription drug costs and the Trump administration's plans for health care reform.
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The latest buzzword now is a single-payer health plan. Another iteration would be Medicare-for-all. Mix in with this is the Affordable Care Act ACA or Obamacare.  The ACA covers a large demographic from birth to end of life. Medicare covers the over 65 elderly, and the disabled. Disabled veterans (service-connected) are eligible for medical services at a VA facility, clinic or hospital.  Just because you are a veteran does not mean you are eligible for free VA medical services. The Indian Health Service, Department of Defense, and the Federal Employees Health Benefit Plan
The GAO and OPM report:  The Department of Defense program is Tricare,

TRICARE is a health program for:

Uniformed Service members and their families,
National Guard/Reserve members includes members of the:
Army National Guard
Army Reserve
Navy Reserve
Marine Corps Reserve
Air National Guard
Air Force Reserve
U.S. Coast Guard Reserve
 and their families,
Survivors,
Former spouses,
Medal of Honor recipients and their families, and
Others registered in the Defense Enrollment Eligibility Reporting System (DEERS).

"Federal Employees Health Benefits Program (FEHBP) enrollees can choose from a number of health plan offerings depending on where they live. From 2007 to 2015, the median number of plan offerings available in a county increased from 19 to 24. Of the 24 plan offerings in 2015, 19 were available nationwide and 5 were health maintenance organization plans offered in specific geographic areas. Yet despite more available plan offerings in recent years, enrollment has become more concentrated within the largest health insurance carrier in a county. Specifically, the median share of enrollment held by the largest carrier in a county increased from 58 percent in 2000 to 72 percent in 2015. Further, one carrier—the Blue Cross Blue Shield Association—was the largest carrier in 93 percent of counties in 2000 and 98 percent of counties in 2015."  Strictly speaking, it is not a government health insurance plan.

This list is a guideline only and patients must verify their eligibility for each plan.  Our health system in the United States is a hodge-podge disorganized system. Enrollment eligibility and benefits change each year and the period for enrollment is for a short two month period from October through early December.  It is not patient-centric, it's organization is centered around expediency for payors and government entities.

Details are available at the links in the article.






Sally Pipes dispels myths surrounding single-payer health care proposals | Fox News Video